Antidepressants' Benefits Outweigh Risks for Children: Meta-Analysis Results Seen as Reassuring

Article excerpt

The latest study looking at the impact of antidepressant treatments on children and adolescents should be reassuring to physicians and parents because it is another indication that prescribing the medications outweighs the risks of not doing so, top psychiatrists say.

"Treating depression in adolescence is a high priority given the teenager's suffering, increased likelihood of substance abuse, and increased risk of self-destructive behavior--especially through suicide and accidents," Dr. Michael S. Jellinek, professor of psychiatry and pediatrics at Harvard University, Boston, said in an interview.

Dr. David Fassler agreed, saying in an interview that the study's findings confirm that selective serotonin reuptake inhibitors can be an effective component of treatment for children and adolescents with depression and other psychiatric disorders.

However, the study does have several significant shortcomings from a methodologic perspective, said Dr. Fassler, professor of psychiatry at the University of Vermont, Burlington.

The results of a meta-analysis of 27 prospective, randomized, placebo-controlled clinical trials of antidepressant therapy in patients under age 19 "support the cautious and well monitored use of antidepressant medications as one of the first-line treatment options," reported Jeffrey A. Bridge, Ph.D., of the Columbus (Ohio) Children's Research Institute, and his associates (JAMA 2007;297:1683-96).

Last year, a Food and Drug Administration meta-analysis concluded that antidepressants doubled the incidence of spontaneous reports of suicidal ideation and behavior from 2% to 4% in the pediatric population, and the FDA then mandated that antidepressant labels carry a boxed warning to this effect.

Dr. Bridge and his associates conducted what they termed a more current literature review and meta-analysis of the issue, which included data from more recent clinical trials. Their study was supported by the National Institute of Mental Health.

Data from 13 trials involving 2,910 children and adolescents with major depressive disorder showed that the absolute response rate was 61% with antidepressants, compared with 50% for placebo. The absolute corresponding rate of suicidal thoughts or behaviors was 3% in those taking antidepressants and 2% in the placebo group.

In the six trials involving antidepressant therapy for 705 subjects with obsessive-compulsive disorder (OCD), the rate of response to selective serotonin reuptake inhibitors was 52%, compared with 32% in the placebo group. The reported rate of suicidal thoughts or behaviors was 1% in SSRI-treated patients and 0.3% in placebo-treated patients.

And in the six trials of antidepressants for 1,135 subjects with non-OCD anxiety disorders, the response rate with antidepressants was 69%, compared with 39% for placebo. …